OBJECTIVES:

For diabetes mellitus (DM) patients who received anti-diabetes therapy, hypoglycemia is a common and serious adverse event which is associated with higher incidence of cardiovascular events and mortality. The aim of this study is to estimate the incidence of hypoglycemia event of DM patients using basal insulin and its related medical utilization.

METHODS:

Data came from the Longitudinal Cohort of Diabetes Patient in Taiwan from 2006 to 2013. A total of 1,060,845 DM patients were included in the cohort. After excluding patients who never use basal insulin (n=1,012,980) and used only 1 time basal insulin during follow-up period (n=14,374), a total of 33,491 patients were included in the analysis.

The duration of basal insulin treatment was defined as the first prescription date of basal insulin and followed to the last prescription date. If the duration of two prescription dates were apart over 30 days, it was identified as a different treatment episode. Hypoglycemia event was defined by the diagnosis.

RESULTS:

During 2006-2013, there were 1,571 hypoglycemia events and 91.4% went to emergency visit. Total follow-up duration was 40,113.28 person-years and the incidence rate per 100 person-year was 3.91 and the mortality was 0.51%. The incidence rate of hypoglycemia was 7.32 and 3.29 per 100 person-year for type I and type II DM, respectively. Furthermore, the combination of basal insulin and other insulin therapy had the highest incidence rate compared to basal insulin plus oral anti-diabetes agent and basal insulin monotherapy group. The mortality of hypoglycemia event were 0.44% and 0.54% for type I and type II DM patients, respectively. The average medical cost per hospitalization due to hypoglycemia was €1,898 and €109 per ER visit.

CONCLUSIONS:

More aggressive anti-diabetes therapy may increase the risk of occurring hypoglycemia. More attention should by paid to prevent hypoglycemia events.